To investigate the mechanical behavior of the post-tensioned prestressed concrete lining (PPCL), the desilting tunnel of the Xiaolangdi Hydro Project in China is adopted as a case, and a detailed three-dimensional continuum model verified by the observation results is established for the PPCL. The radial stresses, longitudinal stresses, axial forces and bending moments of the PPCL under the completed cable tension condition (CCTC) and design water pressure condition (DWPC) are analyzed, respectively. The numerical results reveal that the PPCL concrete is significantly compressed in the circumferential direction by the prestress, while the prestress has a negligible influence on the radial stresses of the PPCL concrete. It should be noted that the concrete near the anchor slots has a complex and adverse stress state with stress concentration, longitudinal tensioning and large bending moment. In addition, a simplified shell model and a further simplified beam model which can take the influences of the prestress loss and the anchor slot into consideration are proposed for the PPCL. The results of the simplified models are in a good agreement with these of the three-dimensional continuum model, and they can be used as efficient approaches for the structural design and analysis of the PPCL.